Intracytoplasmic Sperm Injection and Conventional In Vitro Fertilization Are Complementary Techniques in Management of Unexplained Infertility

Purpose : To evaluate the role of ICSI in unexplained infertility. Methods : In 125 cycles with six or more oocytes retrieved per cycle, sibling oocytes were randomly allocated to IVF or ICSI (group A). In 74 cycles with less than six oocytes retrieved per cycle, cycles were allocated to IVF or ICSI (group B). Results : In group A, ICSI fertilization rate of 61% per allocated oocyte was higher than IVF fertilization rate of 51.6% (P < 0.001). Complete fertilization failure occurred in 19.2 and 0.8% of cycles in IVF and ICSI, respectively (P < 0.001). In group B, fertilization rate in IVF cycles was 53.3% as compared to 60.7% per allocated oocyte in the ICSI cycles (P = 0.29). Complete fertilization failure was higher (P = 0.02) in conventional IVF (34.3%) than ICSI cycles (10.3%). Conclusions : Allocation of sibling oocytes to IVF and ICSI in the first cycle minimizes risk of fertilization failure. For patients with limited number of oocytes, ICSI technique is recommended.     

Nucleolar precursor body distribution in pronuclei is correlated to chromosomal abnormalities in embryos

In-vitro generated human embryos have low implantation rates and high chromosomal abnormalities. Embryos are mostly selected on the basis of microscopic morphological examination. The relationship between pronuclear morphology and chromosomal abnormalities was investigated in this study. Zygotes were scored according to pronuclear morphology on day 1. Excess embryos that were not transferred or cryopreserved on day 3 were fixed. Chromosomes 13, 18, 21, X and Y were analysed by fluorescence in-situ hybridization (FISH). A total of 125 embryos were analysed; 58 (46%) were abnormal, 32 (26%) were mosaic and 35 (28%) were normal. Results were analysed according to different pronuclear morphology. Zygotes with polarized pattern had a significantly lower incidence of chromosome abnormality than those with a non-polarized pattern. The presence of cytoplasmic halo, the size of each pronucleus and the number of nucleolar precursor body had no significant effect on chromosomal abnormalities. In conclusion, embryos generated from zygotes with polarized pattern have fewer chromosomal abnormalities compared with other patterns. A simple microscopic examination during fertilization confirmation would be useful to select embryos with fewer chromosomal abnormalities, preferably in combination with other observations shown to correlate with chromosomal abnormalities.     

Prevention of preterm birth by cervical cerclage compared with expectant management: a systematic review

Our objective was to review the evidence on the use of cervical cerclage to prevent preterm births compared with expectant management. An OVID, MEDLINE, Cochrane Database, and Science Citation Index search using the medical subject headings and terms "cervical cerclage," "cervical incompetence" and "preterm delivery" was conducted for the period 1966 to 2002. We included all randomized trials that evaluated the effectiveness of cervical cerclage in preventing preterm birth. Using a standardized data collection instrument, we reviewed trial designs, inclusion and exclusion criteria, and maternal and neonatal outcome. Fixed or random effects model were used to pool both dichotomous and continuous outcomes where appropriate. Seven trials were identified; six met our inclusion criteria. A total of 2190 women enrolled into the trials were identified with 1110 receiving cerclage and 1080 managed expectantly. There were a total of 278 of 2190 (12.7%) deliveries before 34 weeks of gestation. The meta-analysis demonstrated a trend toward cervical cerclage preventing preterm delivery at less than 34 weeks (OR 0.77, 95% CI, 0.59, 0.99; P =.049). However, there was no demonstrable improvement in neonatal mortality (OR of 0.0.86, 95% CI, 0.56, 1.33; P =.50). There is a trend toward cervical cerclage reducing preterm births before 34 weeks. The use of cerclage is, however, associated with an increased risk of postpartum fever. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to compare the evidence on the use of cervical cerclage with preventing preterm births and to criticize the various articles evaluating the use of cervical cerclage.     

Noncompaction with arcus aorta anomalies

An 18-month-old girl with tetralogy of Fallot (TOF), mental retardation and multiple infarcts on brain computerized tomography (CT) is presented. Her sineangiocardiograms showed a thrombus (moving from the left ventricle to ascending and abdominal aorta), TOF, right arcus aorta with anomalous origin of left subclavian artery from the descending aorta, honeycombed appearance of the apex and half of the posterior wall of left ventricle and the apex of right ventricle. Her echocardiography (ECHO) examinations revealed depressed left ventricular systolic function and thrombus in the left ventricle apex, with noncompaction of the left ventricle apex and the middle portion of posterior wall, and in the right ventricular apex.     

Jejunal intussusception caused by an inflammatory fibroid polyp

The case of a 56-year old male with a jejunal intussusception due to the inflammatory fibroid polyp is presented. In the literature, eleven cases with jejunojejunal intussusception due to IFP were reported. This rare entitiy was reviewed with different perspectives in this report.     

4-(5-chloro-2(3H)-benzoxazolon-3-yl) butanoic acid derivatives: synthesis, antinociceptive and anti-inflammatory properties

In this study, 4-(5-chloro-2(3H)-benzoxazolone-3-yl)butanoic acid and its ethyl ester as well as its ten new amide derivatives have been synthesized. Their structures have been elucidated by IR, (1)H-NMR spectra and elemental analysis. The compounds were screened for antinociceptive and anti-inflammatory activities. The highest antinociceptive and anti-inflammatory activities were exhibited by Compound 11 which has carboxylic acid structure. A various decrease in antinociceptive and anti-inflammatory activity was observed by amidation of the carboxylic acid moiety of this compound.     

Effects of 13-cis-retinoic acid on chemoimmunotherapy of metastatic renal cell carcinoma--results of a retrospective analysis

Chemoimmunotherapy (CIT) with interleukin-2, interferon-alpha2a, and 5-fluorouracil is an accepted treatment option of metastatic renal cell carcinoma (mRCC). Because of the enhancement of the antiproliferative effects of interferon-alpha2a, 13-cis-retinoic acid (13-CRA) might be of potential usefulness for immunotherapy. We have investigated the effect of 13-CRA in patients treated with chemoimmunotherapy. Seventy-two patients with mRCC and a Karnofsky performance index > or = 80% were retrospectively analyzed. Thirty-six patients received chemoimmunotherapy and 36 other patients were treated similarly but with addition of daily 60 mg 13-CRA. Response was assessed according to the UICC criteria. Survival was calculated by Kaplan Meier estimation and compared with the log-rank test. In the CIT group objective remissions occurred in 34.3% (95% CI 19.1-52.2) and stabilizations in 42.9% (median follow-up 16 months). In the CIT plus 13-CRA group, objective remissions were seen in 26.4% (95% CI 12.9-44.4) and stabilizations in 50% (median follow-up 17 months). One- and three-year survival rates were 76% and 32% in the CIT group and 82% and 37% in the CIT plus 13-CRA group. The combination of CIT and 13-CRA did not significantly differ in objective remissions and estimated survival compared with CIT. Our retrospective data suggest that 13-CRA does not enhance the therapeutic efficacy of CIT in mRCC patients with a good performance status.     

Extrapulmonary small cell carcinoma: multimodality treatment results

AIMS AND BACKGROUND: Extrapulmonary small cell carcinoma is a distinct entity that can occur in many sites, and it is pathologically similar to small-cell lung cancer. We report the results of a retrospective study of a multimodality treatment of 16 consecutive patients with a diagnosis of extrapulmonary small-cell carcinoma. METHODS: Primary tumor site was prostate in 2, gallbladder in 2, uterine cervix in 2, liver in 2, endometrium in 1, epididymis in 1, colon in 1, larynx in 1, breast in 1, and unknown primary tumor in 3 patients. Patients' ages ranged from 19 to 79 years (median, 62). Nine patients had limited and 7 had extensive disease. Histologically, 14 were pure extrapulmonary small-cell carcinoma and 2 were mixed with squamous-cell carcinoma. RESULTS: Curative surgery was attempted in 8 patients. Seven patients received local-regional adjuvant radiotherapy. All patients, except the one with a breast primary, were treated with chemotherapy (mostly platinum-based regimens). Overall survival for all patients was 41% and 11% at 2 and 5 years, respectively (median survival, 14 months). Median survival for patients with limited disease was 25 months compared to 12 months for patients with extensive disease (P = 0.05). CONCLUSIONS: Treatment results for extrapulmonary small-cell carcinoma are comparable to those of small-cell carcinomas of the lung. Extent of disease is a significant prognostic factor for survival.